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Cornerstone Alert: Prior Authorization for Repetitive Non-Emergency Transports Expansion Delayed

October 04, 2016


As reported by the American Ambulance Association (AAA), the Centers for Medicare and Medicaid Services (CMS) will not be expanding Prior Authorization for repetitive non-emergency transports on January 1, 2017.


The current reach of the program includes New Jersey, Pennsylvania, South Carolina, North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia.  The expansion originally scheduled for January 1, 2017 would have encompassed all 50 states.


The reason for the delay is that, pursuant to section 515(b) of the Medicare Access and CHIP Re-authorization Act (MACRA), CMS must make determinations as to whether: (1) Prior Authorization saves money, (2) it adversely affects quality of care and (3) it adversely impacts access to care.


According to the AAA, these studies are being conducted and are expected to show the program saves money without adversely affecting quality or access to care.


For EMS agencies in states not yet under Prior Authorization, the AAA highly recommends that you still prepare for it to be implemented, even though it will not go into effect January 1, 2017.


Agencies should still ensure that patients receiving repetitive non-emergency transports meet the requirements for medical necessity by reviewing your documents, obtaining documents from facilities, conducting assessments of repetitive patients, and implementing internal procedures and processes, etc. 


Please note, EMS agencies in states already under Prior Authorization for repetitive non-emergency transports are not affected by this announcement.

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